Pathological Q wave as an indicator of left ventricular ejection fraction in acute myocardial infarction

  • Muhammad S. Tiyantara Faculty of Medicine, Universitas Mulawarman, Samarinda
  • Muhammad Furqon Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda
  • Swandari Paramita Laboratory of Public Health, Faculty of Medicine, Universitas Mulawaman, Samarinda
Keywords: LVEF, non-Q-wave myocardial infarction, pathological Q wave, Q-wave myocardial infarction
Abstract viewed: 1716 times
PDF downloaded: 955 times
HTML downloaded: 281 times
EPUB downloaded: 85 times

Abstract

Background: Q-wave myocardial infarction (QMI) has higher mortality and lower myocardial viability than non-Q-wave myocardial infarction (NQMI), suggesting the existence of pathological Q waves reflects the worse ventricular function. The aim of the study is to determine difference in left ventricular ejection fraction (LVEF) between QMI and NQMI.

Methods: The study design was cross-sectional analysis conducted in patients with AMI that were hospitalized and undergone echocardiography in Abdul Wahab Sjahranie County General Hospital Samarinda during February 2014 to March 2015. Standard 12-lead electrocardiograms (ECG) were recorded at presentation, 1 day and 2 days after the onset of AMI as well as using the classical criteria for pathological Q wave. LVEF assessment was performed using echocardiography after the second day since the onset of AMI. Independent-T test was used to determine difference in LVEF using PSPPIRE 0.8.4.

Results: There were 34 subjects comprising 16 QMI patients and 18 NQMI patients. QMI had a lower LVEF (42±13%) compared to NQMI (60±11%, p<0.001). The presence of pathological Q waves was associated with LVEF ≤40% (p=0.002).

Conclusion: QMI had a lower LVEF than NQMI, provides information about the role of pathological Q wave as an indicator of LVEF.

Author Biographies

Muhammad S. Tiyantara, Faculty of Medicine, Universitas Mulawarman, Samarinda
Medical Student, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia
Muhammad Furqon, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia
Swandari Paramita, Laboratory of Public Health, Faculty of Medicine, Universitas Mulawaman, Samarinda
Laboratory of Public Health, Faculty of Medicine, Universitas Mulawaman, Samarinda, Indonesia

References

  1. Velasco M, Rojas ER. Non-Q-wave myocardial infarction: comprehensive analysis of electrocardiogram and pathological correlation. Síndrome Cardiometabólico. 2011; 1(1):4-10. doi: 10.1097/MJT.0b013e3182459bf5

  2. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/nonâST-elevation myocardial infarction. Circulation. 2013;127:663-828. http://dx.doi.org/10.1161/CIR.0b013e31828478ac

  3. Jeon HK, Shah GA, Diwan A, Cwajg JM, Park TH, McCulloch ML, et al. Lack of pathologic Q waves: a specific marker of viability in myocardial hibernation. Clin Cardiol. 2008;31(8):372â7. http://dx.doi.org/10.1002/clc.20244

  4. Ananthasubramaniam K, Chow BJ, Ruddy TD, deKemp R, Davies RA, DaSilva J, et al. Does electrocardiographic Q wave burden predict the extent of scarring or hibernating myocardium as quantified by positron emission tomography? Can J Cardiol. 2005;21(1):51-6.

  5. Halkin A, Fourey D, Roth A, Boyko V, Behar S. Incidence and prognosis of non-Q-wave vs. Q-wave myocardial infarction following catheter-based reperfusion therapy. QJM. 2009;102(6):401-6. http://dx.doi.org/10.1093/qjmed/hcp037

  6. Armstrong PW, Fu Y, Westerhout CM, Hudson MP, Mahaffey KW, White HD, et al. Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patient treated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2009;53(17):1503-9. http://dx.doi.org/10.1016/j.jacc.2009.01.046

  7. Siha H, Das D, Fu Y, Zheng Y, Westerhout CM, Storey RF, et al. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insight from the PLATO trial. CMAJ. 2012;184(10):1135-42. http://dx.doi.org/10.1503/cmaj.111683

  8. Bonow, Mann, Zipes, Libby. Braunwald's heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier; 2015.

  9. Camm AJ, Lüscher TF, Serruys PW. The ESC textbook of cardiovascular medicine. 2nd ed. Oxford: Blackwell Publishing; 2006.

  10. Sztajzel J, Urban P. Early and late Q wave regression in the setting of acute myocardial infarction. Heart. 2000;83(6):708-10. http://dx.doi.org/10.1136/heart.83.6.708

  11. Voon WC, Chen YW, Hsu CC, Lai WT, Sheu SH. Q-wave regression after acute myocardial infarction assessed by Tl-201 myocardial perfusion SPECT. J Nucl Cardiol. 2004;11(2):165-70. http://dx.doi.org/10.1016/j.nuclcard.2003.10.009

  12. Kelly RF, Sluiter W, McFalls EO. Hibernating myocardium: is the program to survive a pathway to failure? Circ Res. 2008;102(1):3-5. http://dx.doi.org/10.1161/CIRCRESAHA.107.168278

  13. Heusch G, Schulz R, Rahimtoola SH. Myocardial hibernation: a delicate balance. Am J Physiol Heart Circ Physiol. 2005;288(3):984-99. http://dx.doi.org/10.1152/ajpheart.01109.2004

  14. Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E. Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation. 1998;97(18):1848-67. http://dx.doi.org/10.1161/01.CIR.97.18.1848

  15. Tao ZW, Huang YW, Xia Q, Fu J, Zhao ZH, Lu X, et al. Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction. J Zhejiang Univ Sci. 2004;5(4):494-8. http://dx.doi.org/10.1631/jzus.2004.0494

  16. Pride YB, Giuseffi JL, Mohanavelu S, Harrigan CJ, Manning WJ, Gibson CM, et al. Relation between infarct size in ST-segment elevation myocardial infarction treated successfully by percutaneous coronary intervention and left ventricular ejection fraction three months after the infarct. Am J Cardiol. 2010;106(5):635-40. http://dx.doi.org/10.1016/j.amjcard.2010.04.012

  17. Delewi R, Ijff G, van de Hoef TP, Hirsch A, Robbers LF, Nijveldt R, et al. Pathological Q waves in myocardial infarction in patients treated by primary PCI. JACC Cardiovasc Imaging. 2013;6(3):324-31. http://dx.doi.org/10.1016/j.jcmg.2012.08.018

  18. Yang H, Pu M, Rodriguez D, Underwood D, Griffin BP, Kalahasti V, et al. Ischemic and viable myocardium in patients with nonâQ-wave or Q-wave myocardial infarction and left ventricular dysfunction: a clinical study using positron emission tomography, echocardiography, and electrocardiography. J Am Coll Cardiol. 2004;43(4):592-8. http://dx.doi.org/10.1016/j.jacc.2003.07.052

  19. Plein S, Younger J, Sparrow P, Ridgway J, Ball SG, Greenwood JP. Cardiovascular magnetic resonance of scar and ischemia burden early after acute ST elevation and non-ST elevation myocardial infarction. J Cardiovasc Magn Reson. 2008;10:47. http://dx.doi.org/10.1186/1532-429X-10-47

  20. Moon JC, Arenaza DP, Elkington AG, Taneja AK, John AS, Wang D, et al. The pathologic basis of Q-wave and non-Q-wave myocardial infarction. J Am Coll Cardiol. 2004;44(3):554-60. http://dx.doi.org/10.1016/j.jacc.2004.03.076

  21. Cacciapuoti F. Echocardiographic evaluation of ejection fraction: 3DE versus 2DE and M-Mode. Heart Views. 2008;9(2):71-9.

  22. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recomendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17(10):1086-119. DOI: 10.1016/j.echo.2004.07.013

Published
2016-07-26
How to Cite
1.
Tiyantara MS, Furqon M, Paramita S. Pathological Q wave as an indicator of left ventricular ejection fraction in acute myocardial infarction. Med J Indones [Internet]. 2016Jul.26 [cited 2024Apr.25];25(2):98-103. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1274
Section
Clinical Research

DB Error: You have an error in your SQL syntax; check the manual that corresponds to your MySQL server version for the right syntax to use near ') AND metric_type = 'ojs::counter' GROUP BY submission_id ORDER BY metric DESC' at line 1

Stack Trace:

File: /home/mjifkui/public/journal/lib/pkp/classes/statistics/PKPMetricsDAO.inc.php line 192
Function: DAO->retrieve("SELECT submission_id, SUM(metric) AS metric FROM metrics WHERE a...", Array(3))

File: /home/mjifkui/public/journal/classes/statistics/MetricsDAO.inc.php line 39
Function: PKPMetricsDAO->getMetrics(Array(1), Array(1), Array(3), Array(1), Null, True)

File: /home/mjifkui/public/journal/plugins/generic/usageStats/PKPUsageStatsReportPlugin.inc.php line 84
Function: MetricsDAO->getMetrics("ojs::counter", Array(1), Array(2), Array(1), Null)

File: /home/mjifkui/public/journal/plugins/generic/usageStats/OJSUsageStatsReportPlugin.inc.php line 32
Function: PKPUsageStatsReportPlugin->getMetrics("ojs::counter", Array(1), Array(2), Array(1), Null)

File: /home/mjifkui/public/journal/lib/pkp/classes/core/PKPApplication.inc.php line 615
Function: OJSUsageStatsReportPlugin->getMetrics("ojs::counter", Array(1), Array(2), Array(1), Null)

File: /home/mjifkui/public/journal/plugins/generic/recommendByAuthor/RecommendByAuthorPlugin.inc.php line 96
Function: PKPApplication->getMetrics(Array(1), Array(1), Array(2), Array(1))

File: /home/mjifkui/public/journal/lib/pkp/classes/plugins/HookRegistry.inc.php line 107
Function: RecommendByAuthorPlugin->callbackTemplateArticlePageFooter("Templates::Article::Footer::PageFooter", Array(3))

File: /home/mjifkui/public/journal/lib/pkp/classes/template/PKPTemplateManager.inc.php line 1116
Function: HookRegistry::call("Templates::Article::Footer::PageFooter", Array(3))

File: /home/mjifkui/public/journal/cache/t_compile/42362804174f266c598cdb32c3208fc745b92101^1c372c95cd85572e0fbc9a53d0323a0b229cfc78_0.app.frontendpagesarticle.tpl.php line 43
Function: PKPTemplateManager->smartyCallHook(Array(1), Object(Smarty_Internal_Template))

File: /home/mjifkui/public/journal/lib/pkp/lib/vendor/smarty/smarty/libs/sysplugins/smarty_template_resource_base.php line 123
Function: content_661e2adf5094a4_83632276(Object(Smarty_Internal_Template))

File: /home/mjifkui/public/journal/lib/pkp/lib/vendor/smarty/smarty/libs/sysplugins/smarty_template_compiled.php line 114
Function: Smarty_Template_Resource_Base->getRenderedTemplateCode(Object(Smarty_Internal_Template))

File: /home/mjifkui/public/journal/lib/pkp/lib/vendor/smarty/smarty/libs/sysplugins/smarty_internal_template.php line 216
Function: Smarty_Template_Compiled->render(Object(Smarty_Internal_Template))

File: /home/mjifkui/public/journal/lib/pkp/lib/vendor/smarty/smarty/libs/sysplugins/smarty_internal_templatebase.php line 232
Function: Smarty_Internal_Template->render(False, 1)

File: /home/mjifkui/public/journal/lib/pkp/lib/vendor/smarty/smarty/libs/sysplugins/smarty_internal_templatebase.php line 134
Function: Smarty_Internal_TemplateBase->_execute(Object(Smarty_Internal_Template), Null, "42362804174f266c598cdb32c3208fc745b92101", Null, 1)

File: /home/mjifkui/public/journal/lib/pkp/classes/template/PKPTemplateManager.inc.php line 843
Function: Smarty_Internal_TemplateBase->display("frontend/pages/article.tpl", Null, "42362804174f266c598cdb32c3208fc745b92101", Null)

File: /home/mjifkui/public/journal/pages/article/ArticleHandler.inc.php line 216
Function: PKPTemplateManager->display("frontend/pages/article.tpl")

File: /home/mjifkui/public/journal/lib/pkp/classes/core/PKPRouter.inc.php line 390
Function: ArticleHandler->view(Array(0), Object(Request))

File: /home/mjifkui/public/journal/lib/pkp/classes/core/PKPPageRouter.inc.php line 231
Function: PKPRouter->_authorizeInitializeAndCallRequest(Array(2), Object(Request), Array(1), False)

File: /home/mjifkui/public/journal/lib/pkp/classes/core/Dispatcher.inc.php line 134
Function: PKPPageRouter->route(Object(Request))

File: /home/mjifkui/public/journal/lib/pkp/classes/core/PKPApplication.inc.php line 252
Function: Dispatcher->dispatch(Object(Request))

File: /home/mjifkui/public/journal/index.php line 68
Function: PKPApplication->execute()